Healthcare Provider Details

I. General information

NPI: 1457722837
Provider Name (Legal Business Name): ERESULTSPT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2015
Last Update Date: 10/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 21ST ST NW
ROCHESTER MN
55901-0614
US

IV. Provider business mailing address

2202 21ST ST NW
ROCHESTER MN
55901-0614
US

V. Phone/Fax

Practice location:
  • Phone: 507-269-7652
  • Fax: 202-379-1738
Mailing address:
  • Phone: 507-269-7652
  • Fax: 202-379-1738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number7154
License Number StateMN

VIII. Authorized Official

Name: MR. JOSHUA HOLMES
Title or Position: OWNER
Credential: PT
Phone: 507-269-7652